Disability Insurance Lawsuit Stories

The U.S. Court of Appeals for the Fourth Circuit recently agreed with a federal district court in South Carolina that the Federal Express Corporation (FedEx) was blatantly wrong when it denied long-term total disability benefits to its employee who was injured on the job. The claimant, Richard Bilheimer, had been employed by FedEx for eight years when he was involved in his second on the job car wreck. He was ...

You MUST file TWO appeals with Lincoln prior to filing suit!Most long term disability insurance companies only require one mandatory appeal prior to initiating a lawsuit in federal court. Some insurers allow a voluntary appeal after the first appeal is denied, but do not require a second appeal prior to filing suit. However, Lincoln National Life Insurance Company requires TWO MANDATORY appeals before a su...

A Georgia Federal Court recently concluded that Aetna abused its discretion in denying long term disability benefits to an Aetna employee who suffered from chronic pain due to Lupus, Fibromyalgia, Asthma, Hypocalcemia and Mild Degenerative Joint Changes. Aetna unreasonably denied benefits by relying on flawed peer review reports of the plaintiff’s medical records. The court found the reports “ignore and mi...

If you are insured under or receiving disability benefits from an employer provided Group Disability Insurance Policy governed by ERISA your benefit is or will be subject to reduction for sources of "Other Income" benefits you receive while on claim. Of these sources of Other Income Benefits, Social Security Disability (SSDI) benefits are the most common. These provisions are legal and enforceable, but what ha...

A Massachusetts Federal Court recently held that MetLife wrongfully denied long term disability benefits and abused its discretion by failing to address contrary evidence and placing undue weight on certain evidence. The court remanded the case back to MetLife with specific instructions to re-evaluate the claim. This case was not handled by Dell Disability Lawyers but it is a good victory for disability claima...

In a case not handled by Dell Disability Lawyers, a Prudential Claimant has lost her right to sue after being denied disability benefits. In a recent decision by a Circuit Court Judge in the United States District Court for the Western District of North Carolina, a disabled woman's lawsuit against Prudential was dismissed because she unfortunately waited too long to file a lawsuit.The claimant was previous...

Employee Terminated Despite Suffering From Disability Which Impacted His Work PerformanceKevin worked for Ametek, Inc. from 2008 until July 2012, holding various positions over the course of that time. Beginning in 2009 he began suffering a number of serious health problems which forced him to take medical leave until early 2010, at which time he returned to work. Kevin worked, despite his serious health p...

We get many calls involving claims denied based upon exclusions for losses or disabilities resulting from certain excluded conditions. Common excluded losses are those resulting from pre-existing conditions, suicide or attempted suicide, acts of war, or criminal acts.In a recent case out of Kansas, a federal court was faced with determining whether there was a sufficient causal nexus to deny a claim based ...

In a recent long term disability case out of the Puerto Rico United States Federal District Court, a long term disability claimant's ERISA lawsuit was dismissed when the court ruled that MetLife's three year period to file a lawsuit following a claim denial is enforceable. In the case of Santana-Diaz v. Metropolitan Life Insurance Company, which was not handled by our law firm, the claimant argued that the dis...

It is extremely common for insurance companies to deny disability benefits when the basis for the claim is the inability to work due to Fibromyalgia. The reason this happens so often is due to the subjective nature of the illness and lack of the existence of objective proof of the illness. Insurance companies notoriously ignore physicians' opinions that support their patient's inability to work, since these op...

What is an Occupation?Pursuant to the vast majority of ERISA governed disability insurance policies, an Occupation is defined based on one of two standards - Own Occupation or Any Occupation. Quite often an insurance carrier will overlook the actual duties of an occupation and simply determine the ability to work based on the physical demand level associated with a particular occupation. If you are receivi...

When suing an insurance company to recover disability benefits in an ERISA case, the three most likely outcomes by the court are; (1) awarding past benefits, (2) sending the claim back to the insurance company for further review (remand), or (3) finding in favor of the insurance company. The first and second outcomes are a win for the Plaintiff after which the court has discretion to award attorney's fees and ...

In an opinion issued on August 8, 2014 from the United States District - District of Massachusetts, a Federal Judge ruled that Unum's "decision to terminated Doe's benefits was not the product of reasonable decisionmaking and substantial evidence. It was arbitrary and capricious." Unfortunately for the claimant/plaintiff John Doe, the Court failed to award benefits to him and instead remanded the case back to ...

The answer to this question of course, is, it depends...Many plans explicitly define disability as an inability to engage in employment for which the applicant is "reasonably qualified by training, education or experience." This language typically defines the "any occupation" definition of disability. Plans containing this language require Plan administrators to conduct some level of analysis of the claima...

What is a Statute of Limitations?The Statute of Limitations is the amount of time allowed under the law in which a plaintiff can bring a lawsuit. ERISA does not specify a statute of limitations for filing a lawsuit within the language of the statute. As such, insurance companies often write a statute of limitations provision into the policy, the most common being a three year statute of limitations. The st...

It is very common for group disability policies to contain provisions limiting LTD benefits to 12 or 24 months for conditions involving the cervical or lumbar spine as well as soft tissue injuries. It is important to be familiar with your policy language and its limitations prior to filing a claim for benefits, especially if your policy contains a limitation for certain medical conditions. It is often times po...

In an unpublished opinion summarizing a decision of the Sixth Circuit Court of Appeals the court awarded benefits to a Michigan machine operator finding the plan administrator's decision that the claimant could perform a job, which the court described as "[existing] only in theory," to be arbitrary and capricious.Mr. Kennard operated machines for Means Industries, Inc. until 1990 when he inhaled fumes from...

Fibromyalgia and Chronic Fatigue Syndrome are illness of unknown etiology characterized by widespread pain, fatigue, sleep disturbance and psychological distress that affect an estimated 5.8 million Americans. Insurance companies are notorious for denying disability claims based on inability to work due to fibromyalgia or CFS since there is no know test to prove one is stricken with the illness. It was once ea...

Anyone with experience with ERISA lawsuits knows the term "arbitrary and capricious." The term, which describes the standard employed by courts in reviewing most ERISA governed claim denials, acts a shield for insurers and protects their decisions to deny claims as long as they are found to be "rational in light of the plan's provisions." So what does "arbitrary and capricious" actually mean?An analysis of...

California, one of the first states to ban discretionary clauses in disability insurance policies, is home to a recent decision by a federal court judge finding that the state statute banning discretionary clauses does not affect policies issued or renewed before January 1, 2012; and although the statute may void discretionary clauses in the insurance policy, it did not invalidate the discretionary clause in t...